Billable Codes
Exclusion Rules
Common Comorbidities
Associated CPT® Codes
Key Facts
The 2025 edition of Dementia ICD 10 coding went through major changes that started working on October 1, 2024. Medical professionals need these updates for accurate documentation and proper patient care. The ICD-10-CM code F03.90 represents "Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety."
Medical coders must think about the etiology, severity, and behavioral components while coding dementia. ICD-10-CM groups dementia classifications into three main categories based on cause: Vascular (F01.-), Dementia in diseases classified elsewhere (F02.-), and Unspecified/NOS Dementia (F03.-). Severity levels have become a key part of diagnosis codes. These levels are mild (A), moderate (B), or severe (C), each showing different effects on daily activities. The coding system also defines behavioral components such as agitation (-11), psychotic disturbance (-2), mood disturbance (-3), and anxiety (-4). This piece helps you work with these new requirements to accurately document dementia using ICD-10 codes.
The 2025 ICD-10-CM brings major changes to dementia coding. It moves beyond simple behavioral differences to create a more detailed classification system. These updates show how complex dementia can be in clinical settings.
ICD-10-CM groups dementia into three main categories based on what causes it:
F01 (Vascular dementia) - Brain damage from vascular disease causes this type, usually from high blood pressure affecting brain vessels. Small strokes add up over time, and symptoms often start later in life. The 2025 update changed the "code first" rule to "if applicable, any causal condition" instead of just listing cerebrovascular disease.
F02 (Dementia in other diseases classified elsewhere) - This covers dementia caused by conditions other than Alzheimer's or blood vessel problems. Coders must list the underlying disease first. The 2025 update now uses "neurocognitive disorder with Lewy bodies" instead of "dementia with Lewy bodies" and added "other frontotemporal neurocognitive disorder".
F03 (Unspecified dementia) - Doctors use this code when they can't determine the exact type. This code covers presenile dementia NOS, senile dementia NOS, and primary degenerative dementia NOS. The 2025 update no longer lists "senility NOS" in the excludes notes.
Severity became a key part of dementia diagnosis codes on October 1, 2022. Doctors must note the specific severity level based on how it affects daily activities:
Mild dementia (fourth character A) - Daily tasks become harder. Patients need occasional help with complex activities but can still manage basic tasks.
Moderate dementia (fourth character B) - Basic activities become difficult. Patients need frequent help and can't live independently.
Severe dementia (fourth character C) - Patients depend completely on others for care, even for basic self-care. Doctors might not be able to interview these patients.
Unspecified severity - Used when doctors don't specify how severe the dementia is. If a patient's condition worsens during their stay, coders should use the code for the worst severity noted.
Behavioral modifiers add a fifth number to dementia codes. These give important details about symptoms:
Code Z91.83 should be used with the dementia code "with other behavioral disturbance" when noting wandering behavior.
These detailed behavior codes replaced the simple "with/without behavioral disturbance" options. They now give more precise information that helps guide treatment and care plans. Dementia codes without behavioral issues don't count as Complications/Comorbidities (CC), but specific issues like psychotic disturbance or anxiety do.
Code F03.90 plays a crucial role in dementia documentation. A closer look at its components helps us understand how healthcare providers should use this code in medical records.
Healthcare providers should use F03.90 to document dementia cases that meet two conditions. The provider hasn't determined the exact type of dementia (like Alzheimer's or vascular). The patient shows no signs of behavioral, psychotic, or mood disturbances, or anxiety.
This code proves valuable in these cases:
F03.90 qualifies as a billable code for reimbursement and links to the older ICD-9 code 294.2. Healthcare providers need to document both the dementia diagnosis and the absence of behavioral issues accurately.
The "unspecified severity" element in F03.90 shows that doctors haven't clearly defined the level of cognitive decline. This lack of specification affects patient care in several ways:
An unspecified severity often points to an incomplete assessment of the patient's abilities. A full evaluation would normally classify the condition as mild, moderate, or severe based on daily function impact.
Care planning becomes trickier without knowing the severity. Treatment plans and resource allocation work better when providers know if a patient needs minimal support or comprehensive care.
Insurance payments might be affected since payers now expect detailed documentation to support medical services.
This unspecified designation might also show a temporary diagnostic state where doctors plan future evaluations to better understand how the condition affects the patient.
These codes differ mainly in their severity levels and presence of behavioral symptoms:
F03.A0 shows mild severity where patients need help with some tasks but maintain partial independence. F03.C4 indicates severe dementia with complete dependency and anxiety symptoms that need specialized care.
These code differences matter because:
Doctors need to understand these differences to classify patients correctly and provide appropriate care. The codes help guide treatment decisions and affect payment—F03.90 isn't considered a Complication/Comorbidity (CC), while codes with specific disturbances like F03.C4 might be.
Medical professionals need to understand specific character positions and their meanings in the ICD-10-CM system to assign behavioral modifiers to dementia codes correctly. F03.90 forms the base code for unspecified dementia documentation. Additional characters provide key clinical details about patient behaviors.
The 5th character works as a behavioral modifier in dementia coding that shows whether specific behavioral signs are present. The "0" at the end of F03.90 tells us the patient shows no behavioral disturbance, psychotic disturbance, mood disturbance, or anxiety. This position plays a vital role in showing the clinical picture of dementia patients.
The zero (0) as the 5th/final character comes after both type and severity indicators in the new diagnosis code structure:
Patients without behavioral issues need different care plans than those who show such symptoms. This character position helps determine the right approach.
Specific numeric codes replace the final "0" in F03.90 to show behavioral signs in dementia. These codes give detailed information about patient symptoms:
These codes let providers document specific symptoms that affect care needs. Many dementia patients go through phases of agitation, aggression, or combativeness that change their care requirements to stay safe.
Z91.83 identifies wandering behavior in dementia patients. This code must go with dementia codes marked as "other behavioral disturbance" (code ending in 18).
Wandering behavior needs special attention in dementia coding because:
Z91.83 describes wandering but can't be the first-listed or principal diagnosis code. The ICD-10-CM system requires using it after the primary dementia diagnosis, following the etiology/manifestation rule.
Proper dementia coding depends on accurate documentation. Healthcare providers must understand how to correctly apply F03.90, a billable ICD-10-CM code used for reimbursement.
Your documentation must include these elements to support code F03.90 for unspecified dementia:
Medical records should show that doctors have ruled out other potential causes of cognitive decline. The records must also support "unspecified dementia" instead of specific diagnoses like Alzheimer's disease (G30.-) or vascular dementia (F01.-).
Dementia ICD-10 coding severity determination needs:
The 2025 edition of ICD-10-CM F03.90 became effective on October 1, 2024. The "unspecified severity" designation becomes appropriate if severity remains unclear after evaluation. Otherwise, providers should document severity as mild, moderate, or severe based on functional impact.
F03.90 coding has two types of exclusion notes:
Excludes1 notes show conditions that should never be coded with F03.90, as they cannot exist together:
Excludes2 notes represent conditions that can exist alongside F03.90 but are not part of it:
These differences matter because Excludes1 means a "pure excludes" - conditions cannot occur together, hence "NOT CODED HERE!" Excludes2 means "Not included here" where patients might have both conditions at once.
The ICD-10 codes for dementia create a complex diagnostic framework, and F03.90 plays a specific role within it. The coding system splits into different categories based on the mechanisms and clinical signs that patients show.
Doctors must use two codes for Alzheimer's dementia—they start with the disease code (G30.-) and then add the manifestation code (F02.-). The main codes are:
F03.90 works as a standalone code, but Alzheimer's just needs the etiology/manifestation convention. Medical staff must add the right F02 code with behavioral modifiers after they assign the G30.- code. A patient who has mild Alzheimer's without behavioral issues would get G30.9 + F02.A0.
Medical professionals should never use F03.90 at the time Alzheimer's disease appears as the cause of dementia, even without behavioral issues.
Vascular dementia (F01) has a structure similar to F03 codes but is different in several ways:
The system for severity and behavioral modifiers matches F03.90:
Medical staff use F01 codes only when vascular pathology causes dementia. F03.90 comes into play when they cannot determine the cause.
Substance-induced dementia uses a coding structure that's nowhere near similar to F03.90:
These codes combine the substance type with the patient's relationship to it through abuse, dependence, or unspecified use. Each code ends with "7" to show persisting dementia as the manifestation.
Substance-induced codes work differently than F03.90. They don't have separate severity levels or behavioral modifiers. On top of that, they appear in the F10-F19 range instead of F01-F03, which shows their unique cause and disease process.
What should you know about F03.90 coding in 2025?
The 2025 ICD-10-CM updates have substantially reshaped dementia coding, especially when you have code F03.90. In this piece, you'll see how dementia classification now covers both the mechanisms and severity levels that demonstrate behavioral patterns. F03.90 represents unspecified dementia with unspecified severity and without behavioral disturbances.
Accurate documentation remains crucial to proper dementia coding. Your clinical notes must clearly state both the absence of behavioral disturbances and the inability to specify the dementia type. The severity assessment should reflect the patient's functional capabilities when possible. F03.90 remains an option if severity cannot be determined.
The dementia coding structure follows a logical pattern where:
You must carefully distinguish F03.90 from other codes like F01 (vascular dementia), G30 (Alzheimer's disease), or substance-induced dementia codes. Use Z91.83 for wandering behavior when appropriate.
Unspecified codes like F03.90 serve a purpose, but specificity should be your goal. Patient care improves with precise documentation that communicates both cognitive status and behavioral presentation. Reimbursement depends more on this specificity.
We have a long way to go, but we can build on this progress toward more nuanced clinical documentation with the 2025 ICD-10-CM system. This system captures dementia's complex nature better. Your careful application of these codes leads to better patient care and proper resource allocation.
Q1. What does the ICD-10 code F03.90 represent?
F03.90 represents unspecified dementia with unspecified severity and without behavioral disturbances. It's used when the specific type of dementia cannot be determined and the patient shows no behavioral, psychotic, mood, or anxiety symptoms.
Q2. How is dementia severity integrated into ICD-10 codes?
Dementia severity is now indicated by the fourth character in the code: 'A' for mild, 'B' for moderate, and 'C' for severe. The severity level is based on the functional impact on daily activities, with unspecified severity used when not specified by the provider.
Q3. What documentation is required to support the use of code F03.90?
To support F03.90, documentation must include evidence of cognitive decline affecting daily functioning, explicit notation of no behavioral disturbances, confirmation that the specific dementia type is undetermined, and results from a comprehensive clinical evaluation.
Q4. How does F03.90 differ from codes for other types of dementia?
Unlike F03.90, codes for specific types of dementia (e.g., Alzheimer's or vascular dementia) require additional coding to indicate the underlying cause. F03.90 is used when the type of dementia cannot be specified, while other codes are more specific in etiology and may include different coding structures.
Q5. When should the code Z91.83 be used in relation to dementia?
Z91.83 should be used to identify wandering behavior in dementia patients. It must be used in conjunction with dementia codes classified as "with other behavioral disturbance" (ending in 18) and cannot be used as a primary diagnosis. This code is crucial for indicating a high risk of injury in dementia patients who wander.
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